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Sunday, April 19, 2015

Sefula: An A+ for Option B+!

Did you know that a pregnant mother, who is HIV positive, can conceive, carry her baby for 9 months, deliver, breastfeed, and that this child can still be HIV negative? Prior to our trip to Zambia, we had honestly never really thought about it since HIV is not as common in Canada.

Jessica running triage.

The term mother-to-child transmission (MTCT) refers to the transmission of HIV from an HIV-positive woman to her child during pregnancy, labor, delivery or breastfeeding. MTCT is by far the most common way that children become infected with HIV, in fact 90 percent of HIV positive children have contracted the virus through MTCT.

Without treatment, the likelihood of HIV passing from mother-to-child is 15-45 percent. However, antiretroviral drug therapy (also known as ART) and other effective interventions for the prevention of mother-to-child transmission (PMTCT) can reduce this risk to below 5 percent!

In 2013, the World Health Organization

(WHO) issued new guidelines for PMTCT. These new guidelines recommended Option B+, which is lifelong antiretroviral drug therapy (ART) to all pregnant and breastfeeding women living with HIV, regardless of their CD4 cell count or WHO clinical stage in countries whose resources would allow for it.

If a country was unable to provide for Option B+, then the WHO recommended they follow Option B. Option B is similar to Option B+ with all women starting ART therapy during pregnancy. The difference is in Option B, only women with low CD4 cell counts or those with a clinical stage of 3 or 4 would remain on ART. Those women deemed ineligible for life long ART therapy (women with CD4 cell counts over 500 or clinical stages of 1 or 2) would stop ART after the completion of breast feeding. Both Option B+ and Option B are effective forms of PMTCT. Option B+ is the preferred option only because it helps slow the progression of HIV to AIDS for the mother which will help keep the family healthier as a whole.

Back in February, we had researched PMTCT in order to prepare for our trip to Zambia and as a result we were aware of the WHO guidelines. In a high resourced country such as Canada, there is no question that Option B+ is and should be implemented but we were curious to see if Option B+ would be possible in such a resource limited setting like Zambia.

Fast forward to this past week at Sefula Health Clinic, which is located approximately 40 minutes outside of Mongu.

Jessica walking to Sefula.

When we pictured going to Sefula Health Clinic, we initially expected it to be similar to what a Public Health Center is like in Canada. When we arrived, we were given a tour of the building and quickly realized that Sefula Health Clinic is actually a small rural hospital.

Sefula Rural Health Clinic.

While in Sefula, we had the opportunity to work with an amazing nurse named Barbara, who introduced us to management of HIV positive mothers in Zambia. We were so excited to see that they are implementing the most current WHO recommendations, and you guessed it, Option B+! All of the HIV positive mothers that we saw in our antenatal appointments had been starting on ARTs regardless of their CD4 cell count, and will remain this way for life. We were amazed that this practice was being implemented, in such a rural, resource limited area. We expressed our thoughts to Barbara, and she explained that there is such a good uptake of services because of the wonderful education these women are receiving from community health volunteers. The

Sefula Heath Clinic serves the roughly 9000 people that live within Sefula itself as well 9 different districts on the outskirts. As you can imagine this is a very large catchment area for such a small clinic so adequate access to health care for everyone is a real challenge. Fortunately, the Sefula Health Clinic is currently working with 25 amazing community health volunteers who are working to improve access to health care. These volunteers are people who live in Sefula and the surrounding area, and have been educated informally by the health practitioners at Sefula Health Clinic. These people are extremely passionate about the health of their community, and are committed to helping their people. Many of these volunteers are women who are experts on PMTCT. They are trusted and respected members of the community, and the people listen to them.

Barbara, the nurse who ran Sefula the week we were there.

Sefula catchment area map.

Antiretroviral medication dosing for infants.

Since they officially formed last year, there have been no reported cases of maternal death which is an amazing achievement! We also noticed that during our week at Sefula Health Clinic, not one child of HIV positive mother tested positive for HIV. Their interventions are working and it's absolutely amazing! It gives us chills just writing about it.

These volunteers and nurses offer an extremely effective PMTCT program, where the women and their infants receive a cascade of interventions including uptake of antenatal services and HIV testing during pregnancy, use of antiretroviral treatment (ART), and they ensure safe childbirth practices by recommending coming into the clinic, or ensuring they have a skilled birth attendant. They also teach appropriate infant feeding, uptake of infant HIV testing and other post-natal healthcare services.

Mothers in the antenatal education day. They are holding Polaroid photos we took of them and their babes!

Courtney and her buddy.

Throughout the week we had the opportunity to work in the antenatal clinic. We performed exams, worked with mothers to detect and treat other opportunistic infections as well as STI’s, and we helped educate and counsel around medication, labor and delivery of baby, infant feeding, and safe sex. The clinic ran so smoothly, the women looked so happy and healthy, and we realized that this is what capacity building is all about.

A community health volunteer teaching sexual education and birth spacing to the women.

Without these community health volunteers (and of course Barbara and the wonderful staff at the clinic), the health of the community would be much lower. Together, they are working together with the nurses to facilitate ART retention among and to improve their infant outcomes. Sefula is doing an amazing job of bridging maternal, newborn and child health services with HIV care and treatment at community and facility level.

- Courtney & Jessica

A photo of a woman in the hospital. She was so beautiful and wonderful to visit!